The days are getting longer, which means I don’t leave and arrive home in the dark any longer.
A few more chirps are in the air, more bugs on the windshield, and I can hear the distant whine of a lawnmower. Spring flowers in the Phoenix desert are very transient, and made more precious because of it. It’s all good stuff.
Your immune system is also waking up from a winter’s hibernation.
The immune system, for all we have learned about it during the past 15 years of AIDS research, still remains somewhat of a black box. Allergens in, sneezes out.
You actually can’t be allergic to something your body has never seen before. Yes, you can run buck naked through the poison ivy patch without fear of rash; as long as you are correct that you have never come into contact with it before.
Once your body has seen an allergen, it starts making antibodies against it. That is the least understood detail of this whole process.
The system works well when you quite sensibly make antibodies against flu, polio or measles. When you make them against ragweed, or your own heart or muscle proteins, you have allergies or worse, autoimmune disease. And note that allergies don’t turn into autoimmune disease.
So you have made lots of antibodies against spring pollen. These little IgE antibodies are like circulating time-bombs, peacefully going round and round until they run into one of these pollens/allergens. The mystery is why one person develops antibodies against mulberry trees, and the next one doesn’t.
Once the IgE antibodies and allergen meet, a reaction occurs that medicine has pretty well figured out. This IgE-pollen complex finds a mast cell and causes histamine to be released. Mast cells release histamine to fight this terrible invasion of pansy or petunia – pollen.
Histamine sounds familiar from all the thousands of antihistamine commercials we have sat through. There is a pretty good reason to have an antihistamine because histamines make vessels in the nose and sinuses leaky; thus the runny nose and sneezing.
Histamines also cause inflammation in mucus membranes, including the ones lining the eyes. The result: red, itchy, watery eyes. The lungs often get into the act with inflammation in the tiny vessels lining the airway. This can cause a cough, or in some people, wheezing.
Put up with this for 3-6 months and see how much you’re enjoying life!
The good news is we have been battling histamine and allergies for a long time and almost everyone can be helped. Mast cell stabilizers stop the mast cells from leaking histamine. These medications come in eye drops and nose spray, and are generally well tolerated and a pretty elegant solution if your symptoms are worse in your eyes or nose.
One of the most effective things you can do when Allergic Rhinitis (nasal inflammation) occurs is use a nasal steroid spray. This dramatically reduces the inflammation in the nose. Since the eyes and chest connect, nasal steroids often help combat all allergy symptoms.
Antihistamines and antihistamine/decongestants are the most common treatment for allergies. The medications are pretty effective, but they are sedating to some patients.
We now have non-sedating antihistamines – and they work. With any antihistamine you will have increased symptom control if you use them on bad days and occasionally take a day off these meds.
Immunotherapy is done by allergists; it’s the classic allergy shot series. There are mixed results from shots; some patients do wonderfully and some do not. One of the problems with immunotherapy is we don’t really understand why you started attacking stuff that isn’t too threatening (flower pollen).
Like everything else, lifestyle can be helpful for allergies. A radical approach – move. People with bad allergies may move to the desert to escape the offending pollen. Of course, sometimes you develop allergies to the desert pollen.
You can banish pollen from your house by keeping your windows closed, effectively keeping the outside – outside. Another factor is clean surfaces. Tile is cleaner that carpet and shutters are cleaner that drapes. I suppose spandex is cleaner than fir (but perhaps we go too far).
Allergic Rhinitis is a well understood condition. There are a variety of good treatments and almost everybody can be helped.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona
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